A recent study has raised concerns about the widespread prescription of antidepressants for chronic pain, warning that many of these drugs are being recommended with limited evidence of their effectiveness.
Chronic pain affects about one-third of the global population, according to the World Health Organization, and antidepressants are frequently prescribed as part of treatment to relieve pain.
However, researchers found that the scientific support for many of these drugs is insufficient, prompting calls for healthcare guidelines to be updated.
Published in the Cochrane Database of Systematic Reviews, this investigation analyzed 176 trials involving nearly 30,000 patients taking antidepressants for chronic pain. The drugs included amitriptyline, fluoxetine, citalopram, paroxetine, sertraline, and duloxetine.
Among these, duloxetine was the only one with consistent evidence of pain relief, particularly for fibromyalgia, musculoskeletal pain, and neuropathic pain. Standard doses of duloxetine were shown to be as effective as higher doses, offering a more reliable option for pain management.
In contrast, other antidepressants, including amitriptyline—a commonly prescribed drug for pain—lacked strong evidence for long-term pain relief. For instance, in England alone, about ten million prescriptions were issued for amitriptyline in low doses for pain management over the past year.
Despite its popularity, researchers could not find substantial proof of its long-term benefits or safety in managing chronic pain.
The study’s lead author, Professor Tamar Pincus of the University of Southampton, highlighted that there is little to no reliable evidence for the long-term safety and effectiveness of antidepressants for chronic pain.
She described the reliance on these medications as a “global public health concern” due to the lack of concrete evidence on their long-term impact.
While duloxetine did show short-term benefits for some patients, the researchers remain cautious about its potential long-term risks because of the limited data available.
The study represents the largest assessment to date of antidepressants recommended for chronic pain by major health bodies like the UK’s National Institute for Health and Care Excellence (NICE) and the U.S. Food and Drug Administration (FDA).
The researchers argue that these bodies should revise their guidelines to reflect the new findings. Gavin Stewart, a review co-author from Newcastle University, emphasized the need to stop funding small, flawed trials and focus on more rigorous studies that provide clear evidence.
He explained that the evidence supporting current treatments is “not equivalent,” making some treatment choices hard to justify.
Recommendations for Future Treatment
For those dealing with chronic pain, the review’s findings underscore the importance of a person-centered approach to treatment.
Prof. Pincus recommends that when patients and healthcare providers consider antidepressants for pain, they should start with drugs that have reliable evidence, like duloxetine.
She also stressed that patients should not stop any prescribed medications without consulting their doctors, as individual treatment plans are tailored based on each person’s needs and health history.
The study further suggested that milnacipran, another antidepressant, might also be effective for pain relief, but there are fewer studies supporting its use, making researchers less confident in its efficacy compared to duloxetine.
This study highlights a significant gap in evidence for the long-term use of most antidepressants for chronic pain and calls for healthcare providers and policymakers to update their guidelines accordingly.
The researchers’ message is clear: more high-quality research is needed to support the use of antidepressants in chronic pain treatment. Meanwhile, patients and doctors should work closely to make informed, personalized decisions, especially when considering treatments with stronger evidence.
For those interested in chronic pain management, studies also suggest that around one in three people with chronic pain turn to medical marijuana, and exercises like powerlifting may help alleviate chronic low back pain.
If you care about mental health, please read studies about how dairy foods may influence depression risk, and 6 foods you can eat to improve mental health.
For more mental health information, please see recent studies about top foods to tame your stress, and Omega-3 fats may help reduce depression.
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